[The Artist at the hospital: A musical experience in pediatric hemodialysis]. / L'Artiste en milieu hospitalier : une expérience musicale en hémodialyse pédiatrique.

Culture at the hospital is part of a policy of providing everyone access to culture. This article describes a musical intervention that provides patients and healthcare professionals a central role in creation; qualitatively assesses the benefits of these interventions for children and caregivers; evaluate the lessons learned from this ongoing experience in the pediatric hemodialysis unit of Rouen University Hospital. Ninety-minute sessions take place twice a week, with eight children aged from 18months to 19years, during dialysis. To assess the effects of artistic interventions in the unit, a qualitative methodology was chosen (observation grid). The progression of the project is evaluated to highlight what has helped the children and caregivers reach autonomy in artistic creation while respecting the time allotted, the artistic approach, and the esthetics of each participant's creation. The results indicate that this approach allows children to be actors, that the time at the hospital is relativized, and that the relationship with the healthcare professionals is less oriented towards care. A discussion follows on the place of the artist and the untapped potential of bringing patients to the creative act; the issue of esthetics, which then becomes secondary; the complementarity between musical activities and creation, and the role each actor plays in an artistic project. The hospital can provide access to culture; however, it is possible to go further and reveal patients' creativity.

[Neuromuscular abnormalities in critical illness]. / Neuvièmes Journées des Maladies du Système Nerveux Périphérique.

Critical illness neuromuscular abnormalities (CINMA) are found in 25 percent of ITU patients who recover consciousness and are characterized by a bilateral and symmetric weakness that involves the four limbs but spares the facial muscles. Electrophysiological testing shows an axonal sensory motor polyneuropathy and/or myopathy. The main risk factors of CINMA are prolonged durations of multiple organ failure and mechanical ventilation, use of corticosteroids and hyperglycaemia. CINMA contribute also to increase the duration of mechanical ventilation, this effect being mediated by diaphragm weakness. The median duration of limb weakness is 21 days, although it can exceed several months in some patients. Few preventive measures have been assessed. Whether the benefit of strict blood glucose control in ITU patients recovering from heart surgery on CINMA incidence can be extended to medical ICU patients needs to be determined.

Added value of high-resolution MR imaging in the diagnosis of vertebral artery dissection.

BACKGROUND AND PURPOSE: The optimal imaging method for the diagnosis of VAD remains undefined. Our aim was to evaluate the added value of HR-MR imaging for the diagnosis of VAD. MATERIALS AND METHODS: We retrospectively extracted 35 consecutive patients suspected of having acute VAD who had the following: 1) a focal lumen abnormality of the VA on CE-MRA, 2) HR-MR imaging during the initial hospital stay, and 3) clinical and imaging follow-up within 6 months. Two neurologists classified patients as either VAD (group A) or non-VAD (group B) by reviewing all the available data at hospital discharge, except HR-MR imaging data. On HR-MR imaging, 2 radiologists searched for signs of acute VAD. The 2 classifications were compared. In case of discordance, CE-MRA follow-up and axial fat-suppressed T1WI, used to obtain supportive evidence for or against VAD, were considered as the standard of reference. RESULTS: In 4/18 patients in group A, HR-MR imaging did not demonstrate any signs of acute VAD and perivertebral signal-intensity changes were attributed to venous plexus, with an unchanged lumen on follow-up. In 4/17 patients in group B, HR-MRI demonstrated a mural hematoma, with lumen normalization on follow-up CE-MRA. CONCLUSIONS: Our results encourage the use of HR-MR imaging as a second-line diagnostic tool in the event of suspicion of acute VAD and doubtful findings on standard imaging.